Posts Tagged ‘emergency room’

Income Disparities Impact Healthcare Availability

Monday, April 2nd, 2012

There are limited affordable choices for Americans who do not have health insurance through their jobs, especially for those with low and moderate incomes.  Few are Medicaid-eligible, and locating a plan on the individual market equals paying high premiums.  According to the Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults, 2011, nearly 57 percent of adults aged 19 to 64 in families earning less than 133 percent of the federal poverty level ($29,726 for a family of four) were uninsured for a time in 2011 and 41 percent) were uninsured for a year or longer.  In contrast, only 12 percent of adults earning 400 percent of poverty or more ($89,400 for a family of four) were uninsured during the year, with four percent having no healthcare insurance for one year or longer.

The lack of health insurance significantly makes it difficult to get needed healthcare.  Low- and moderate-income adults who were uninsured in 2011 were much less likely to have a regular source of healthcare than those who did have insurance.  Additionally, uninsured low- and moderate-income adults were more likely to cite factors other than medical emergencies as reasons for going to the emergency room.  These included needing a prescription drug or lacking a regular primary-care physician.

The survey also demonstrates how vital Medicaid and the Children’s Health Insurance Program (CHIP) are in providing health insurance to children in low- and moderate-income families.  More than 63 percent of adults with children under 133 percent of the poverty level and nearly 38 percent with incomes between 133 percent and 249 percent of poverty said that some or all of their children were covered by either program.  The Patient Protection and Affordable Care Act (ACA) will expand the ability of Medicaid and CHIP to cover children and families by targeting adults in low- and moderate-income families who are at the greatest risk of lacking health benefits through a job.

When it becomes fully effective in 2014, the ACA will provide near-universal health insurance through a broad expansion of Medicaid, premium tax credits that cap premium contributions as a share of income for people purchasing private health plans through new state insurance exchanges.  Another benefit is new insurance market rules that prevent health insurers from denying coverage or charging people with pre-existing medical conditions higher premiums.

Or, as the Washington Post’s Sarah Kliff puts it, “While the private insurance expansion could get thrown into limbo by the Supreme Court, there’s pretty widespread agreement that, absent full repeal of the bill, health reform’s Medicaid expansion is here to stay.  And that means a wide-reaching expansion of the entitlement program about two years from now.”

According to the Commonwealth Fund’s analysis, as a result of the Affordable Care Act, the majority of the 52 million adults who did not have health insurance in 2010 will gain coverage beginning in 2014.  Millions more will benefit as their ability to afford the price of premiums and out-of-pocket costs improves.

Karen Davis, President of the Commonwealth Fund, said that “The silver lining is that the Patient Protection and Affordable Care Act has already begun to bring relief to families.  Once the new law is fully implemented, we can be confident that no future recession will have the power to strip so many Americans of their health security.”

Amanda Peterson Beadle, writing on the thinkprogress.org website, notes that “The Affordable Care Act has already expanded health insurance to 2.5 million 19-to-25 year-olds, banned lifetime limits on health insurance coverage, created pre-existing condition insurance plans providing health insurance options to those who were often uninsurable, and required insurers to cover preventive care without requiring co-payments.  But the major provisions of the law to be implemented in 2014 will have the biggest effect on narrowing the income divide.”

The Checklist Manifesto

Wednesday, February 24th, 2010

Surgeon Atul Gawande believes that a simple checklist can cut deaths from operating room errors. Atul Gawande, general and endocrine surgeon at Boston’s Brigham and Women’s Hospital, Associate Professor of Surgery at Harvard Medical School, and columnist for The New Yorker, has written “The Checklist Manifesto:  How to Get Things Right”,  a book that describes how miscommunication in the operating room can lead to tragic results.  Currently, Gawande’s book ranks # 10 on the New York Times’ list of best-selling non-fiction books.

The book grew out of work Gawande did for the World Health Organization, which asked him to help them find a way to reduce surgical deaths.  According to Gawande, “We knew we had technology and incredible levels of training, people working unbelievably hard.  But we have more than 100,000 deaths just in the United States following surgery.  Half are avoidable, from our studies.  What could we do?  We have found this idea, this extra tool that others were using in aviation, in skyscraper construction, and thought, well, let’s give it a try.”

Surgeons, according to Gawande, are human.  “We miss stuff.  We are inconsistent and unreliable because of the complexity of care.”  To achieve better results, Gawande brings a simple checklist into the operating room to make certain that everything is in place to assure a successful procedure.  For example, when the operating team is introduced to each other by name, the average number of complications and deaths fell by 35 percent.

Commenting on the success of checklist use in the operating room, Gawande says “I have not gotten through a week of surgery where the checklist has not caught a problem.”

Walk-In Clinic A Good Fit With the Healthcare Village

Thursday, May 28th, 2009

Urgent care centers (Illinois law mandates that they be called immediate or convenient care centers) are gaining ground nationwide as an alternative for families with minor medical emergencies that require quick treatment.  Although the walk-in clinic concept has been around for more than 20 years, the trend is picking up steam in an increasingly cost-conscious healthcare environment.  emergency_roomApproximately 8,000 such facilities currently are open for business in the United States.

A 2008 survey by the Urgent Care Association of America found that most centers are owned by physicians, and approximately 15 percent are hospital affiliated.  More than 55 percent are located in suburbs, where well-off patients with private insurance are unwilling to spend hours waiting in an emergency room.  The survey found that of an average of five employees, 1.7 are physicians; 0.4 are nurse practitioners; 0.7 are registered nurses; and 2.3 are clinical staff or medical assistants.  Sixty percent of patients are seen by a physician, nurse practitioner or physician’s assistant in just 30 minutes.

Alter+Care sees immediate care centers as a great fit with Alter+Care’s Healthcare Village concept (our concept of a wellness/preventive-focused outpatient campus, see www.healthcarevillage.net, because the village becomes a healthcare destination while generating visibility and visits for all services located in the village such as diagnostics/imaging, specialty clinics, physician practices, retail healthcare, laboratory and the wellness center.  For patients, the centers provide easy access and reasonably priced care because they typically charge far less than an emergency room visit.  Insurers who want to control costs are encouraging people to use urgent care facilities as an alternative, especially during after hours and on weekends.